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VAERS Report 2157436

Case Report Section

Vaer Report Details

Age: NA

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: acb8491


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-20
Date of Onset
5
Number of days (onset date – vaccination date)
5
Adverse Event Description

laboratory confirmed covid-19; laboratory confirmed covid-19; ra this is a non-interventional study report from the regulatory authority-web and product quality group. a 44 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 20jan2022 (lot number: acb8491) as dose 3 (booster), single, administration date 24aug2021 (lot number: fg6273) as dose 2, single and administration date 13jul2021 (lot number: ff0688) as dose 1, single for covid-19 immunisation. relevant medical history included: "alcoholism" (unknown if ongoing); "bilateral saphenectomy" (unknown if ongoing); "carotid thromboendarterectomy ", start date: 2021 (unknown if ongoing), notes: diagnosis in 2021; "hypertension arterial" (unknown if ongoing); "appendectomy" (unknown if ongoing). concomitant medications included: cardioaspirin; omeprazole; benerva; bisoprolol; atorvastatin; eskim. the following information was reported: covid-19 (medically significant), drug ineffective (medically significant) all with onset 25jan2022, outcome "unknown" and all described as "laboratory confirmed covid-19". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (25jan2022) positive, notes: swab. sender comment: the report came from the regulatory authority study. all the data in our possession have already been entered. the reporter's assessment of the causal relationship of the "laboratory confirmed covid-19" with the suspect product(s) bnt162b2 was not provided at the time of this report. since no determination has been received, the case is managed based on the company causality assessment. no follow-up attempts are possible. no further information is expected.; sender's comments: the efficacy of a drug varies from patient to patient and can be affected by different factors; however, a contributory role of the suspect product bnt162b2 to the reported drug ineffective / covid-19 cannot be ruled out.,linked report(s) : it-pfizer inc-202200307290 same patient/product, different dose/events

Lab Data
test date: 20220125; test name: laboratory confirmed covid-19; test result: positive ; comments: swab
List of symptoms
drug ineffective covid-19 sars-cov-2 test
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na